Footcare


Why it is a priority:

  • The annual number of diabetes-related leg, toe or foot amputations in England has reached an all-time high of around 7,400 a year, which is over 140 amputations a week or 20 per day. 
  • People with diabetes are estimated to be up to 30 times more likely to have an amputation compared with the general population and up to 80% of people with diabetes die within five years of having an amputation or a foot ulcer. 
  • Only 50 per cent of people with diabetes who have an amputation survive for two years. The relative likelihood of death within five years following amputation is greater than for colon, prostate and breast cancer.

The majority of diabetes-related amputations are caused by a “foot attack” – a foot ulcer or infection failing to heal. It is estimated that 5-7% of people with diabetes will have a diabetic foot ulcer at some point in their lives, at an estimated cost of £935 million to the NHS. When people with a foot attack get rapid access for treatment by a specialist multi-disciplinary team this has been shown to promote faster healing and fewer amputations, saving money and lives. It is thought that four out of five amputations could be prevented in such way.

 

Amputation is not only devastating in its impact on the person with diabetes and their family, leading to loss of independence and livelihood; it is also expensive for the NHS. Over £119 million is spent each year in England on diabetes-related amputations.

 

The All Party Parliamentary Group on Vascular Disease report (March 2014) stated that a major driver of high amputation rates is the lack of a specific patient pathway for dealing with peripheral arterial disease patients. A Freedom of Information request showed that from 2009 to 2012, Clinical Commissioning Group areas without a patient pathway had 11% more amputations on average than those with a patient pathway.  Expert opinion suggests that once a patient is diagnosed with critical limb ischaemia, early intervention is likely to hold the key to reduced lower limb amputation rates.

Investment into multi-disciplinary footcare teams is entering the region through the Treatment and Care Programme in order to reduce amputations by improving the timeliness of referrals from primary care to a multi-disciplinary foot team for people with diabetic foot disease. 

 

Our Work:

The Y&H Diabetes Clinical Network is facilitating a Root Cause Analysis of major amputation of the foot or lower leg. The objectives of this piece of work are:

  • To reduce the number of major amputations through understanding the treatment and diagnosis of deteriorating diabetic foot disease.
  • To inform QI cycles and improve treatment pathways.

 

The Y&H Diabetes Clinical Network is also:

  • Hosting the Yorkshire and Humber Diabetic Foot Network 
  • Supporting providers to participate in the new National Diabetes Foot Care Audit (NDFA) which launched in July 2014.
  • Collating and presenting Y&H foot care datapacks at Y&H and CCG level to identify variation in a range of diabetic foot care metrics.
  • Sharing good practice in the commissioning and delivery of risk stratified, integrated foot care pathways.
  • Reporting on access to Y&H Acute Foot care MDT / Diabetic Foot MDT as per NADIA audit and feedback at Sub Regional level.

 

Links and Documents: 

The National Diabetes Footcare Audit

CCG Quality Assurance Resources for the Diabetic Foot Pathway

Ampshoes 

Self-assessment tool for local foot care pathways

Integrated Footcare Pathway Tool

Y&H Footcare Profiles Dashboard

PHE Footcare Profiles 

A copy of the RCA tool can be obtained by contacting england.yhdiabetescn@nhs.net.

 

 

  

The annual number of diabetes-related leg, toe or foot amputations in England has reached an all-time high of around 7,400 a year, which is over 140 amputations a week or 20 per day. People with diabetes are estimated to be up to 30 times more likely to have an amputation compared with the general population and up to 80% of people with diabetes die within five years of having an amputation or a foot ulcer. Only 50 per cent of people with diabetes who have an amputation survive for two years. The relative likelihood of death within five years following amputation is greater than for colon, prostate and breast cancer.

The majority of diabetes-related amputations are caused by a “foot attack” – a foot ulcer or infection failing to heal. It is estimated that 5-7% of people with diabetes will have a diabetic foot ulcer at some point in their lives, at an estimated cost of £935 million to the NHS. When people with a foot attack get rapid access for treatment by a specialist multi-disciplinary team this has been shown to promote faster healing and fewer amputations, saving money and lives. Diabetes experts estimate that four out of five amputations could be prevented in such way.

Amputation is not only devastating in its impact on the person with diabetes and their family, leading to loss of independence and livelihood; it is also expensive for the NHS. Over £119 million is spent each year in England on diabetes-related amputations.

The All Party Parliamentary Group on Vascular Disease report (March 2014) stated that a major driver of high amputation rates is the lack of a specific patient pathway for dealing with peripheral arterial disease patients. A Freedom of Information request showed that from 2009 to 2012, Clinical Commissioning Group areas without a patient pathway had 11% more amputations on average than those with a patient pathway.  Expert opinion suggests that once a patient is diagnosed with critical limb ischaemia, early intervention is likely to hold the key to reduced lower limb amputation rates.

Investment into multi-disciplinary footcare teams is entering the region through the [Treatment and Care Programme] in order to reduce amputations by improving the timeliness of referrals from primary care to a multi-disciplinary foot team for people with diabetic foot disease. There is good evidence for multi-disciplinary footcare teams in:

·         Reducing the rate of amputations and reducing the need for hospital admissions of people with active foot disease

·         Cost savings that significantly exceed the cost of putting multidisciplinary footcare teams in place

 

Our Work:

 

The Y&H Diabetes Clinical Network is conducting a Root Cause Analysis of major amputation of the foot or lower leg. The objectives of this piece of work are:

·         To reduce the number of major amputations through understanding the treatment and diagnosis of deteriorating diabetic foot disease.

·         To inform QI cycles and improve treatment pathways.

The Y&H Diabetes Clinical Network is also:

·         Supporting providers to participate in the new National Diabetes Foot Care Audit (NDFA) which launched in July 2014.

·         Collating and presenting a Y&H foot care data pack at CCG level to identify variation in a range of diabetic foot care metrics.

·         Sharing good practice in the commissioning and delivery of risk stratified, integrated foot care pathways.

·         Facilitating the utilisation of Diabetes UK putting feet first patient education leaflets in all GP practices in Yorkshire & the Humber.

·         Reporting on access to Y&H Acute Foot care MDT / Diabetic Foot MDT as per NADIA audit and feedback at Sub Regional level.

[MG to provide text on RCA]

 

 

Links and Documents:

 

Audit report: http://www.hqip.org.uk/resources/national-diabetes-foot-care-audit-report-2014-2016/

 

To facilitate the self-assessment of local foot care pathways an assessment tool was developed. A summary sheet can be found here and a copy of the assessment tool can be found here.

A regional foot care data summary based on the Foot Care Profiles can be found here.

Foot care activity profiles link needed.

 

http://www.ampshoes.co.uk/

 

[RCA Tool]

 

 

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